September 10th, 2013
Have We Solved The Problem of Ghostwriting?
Harlan M. Krumholz, MD, SM
Several years ago, in the midst of the Vioxx litigation, I became aware of the practice of ghostwriting throughout academic medicine. In general, marketing arms of pharmaceutical companies wanted to seed the peer-reviewed journals with articles published by academics. They would identify an academic and provide him or her drafts of the article. Sometimes they would pay the academic for the review. Sometimes the author was a consultant to the company, and there was no direct payment for the review. The article would typically not acknowledge the relationship — or who actually drafted the article. Joe Ross, Kevin Hill, David Egilman and I wrote about this practice in an article published in JAMA.
Even after publishing that article, I have received invitations to be a first author on review articles that would be drafted for me. I was usually approached by a medical writing company. I have been offered payment for my trouble. I have been told that the effort would not take much of my time. As you might imagine, I do not respond to such inquiries.
In a recent issue of a well-regarded, peer-reviewed journal, I ran across a review article by a prominent academic physician that focused, in part, on a controversial subgroup interaction found in a manufacturer-sponsored clinical trial of a new drug. In my opinion, the content was favorable for the new drug.
The article is completely transparent about its genesis. There is a statement that staff from a medical communications company assisted in drafting the article. The article also states that the manufacturer of the new drug paid for the medical writing support. The author was not paid for the article and disclosed no conflict of interest. However, the disclosure does not explicitly state whether the author had a financial relationship with the pharmaceutical company.
In the past, this article may have been ghostwritten. Now, the connection with the medical writing company is transparent — as is the relationship between the pharmaceutical company and the medical writing company. I wonder if this is progress.
Do you see any problem with this practice?
3 Responses to “Have We Solved The Problem of Ghostwriting?”
NEJM Journal Watch — Recent Cardiology Articles- Sex-Based Disparity in CABG Outcomes: Are We Moving Toward Parity?
- Can Genetic and Social Risk Scores Improve Cardiac Risk Prediction?
- Extensive Ablation vs. Pulmonary Vein Isolation in Persistent Atrial Fibrillation
- Can a Novel Stent Design Improve Long-Term Outcomes of Percutaneous Coronary Intervention?
- Are Angiographically-Derived Coronary Physiology Measurements Ready for Use in the Cath Lab?
Ghostwriting and conflict of interest in publishing is a very real problem, with no simple answer. The short answer is that transparency is definitely progress, even if not the final solution. Academic publishing is fraught with conflict of interest, even when money is not in play. Publication, with its inherent recognition, is the currency of academia. More powerful results yield a higher status journal and greater recognition – in many cases tenure. Every academic is inherently conflicted by the subconscious desire to be recognized for our work. Some are more attuned to this bias and can present fair and unbiased reporting of studies they have conducted, while others choose to present the most favorable results, and a small number present fraudulent results.
Transparency is a very real solution, but should include making the research database available freely (as with the tPA stroke trial) or at least to the editor of journal that will publish the results. For controversial or dramatic results, editors should consider requiring an independent statistician or epidemiologist review the database to confirm the results, with their comments made public with the publication.
Transparency is the solution, but let’s define it further. Simply stating that one consults for a company is not the full definition.
There is no problem about ghostwriting. It is deliberate deception and we should be disgusted and outraged by it, not engage in special pleading to justify our special needs. We long ago hit rock bottom. It’s time to begin restoring some sort of decency in the profession.
Louis Krut
As with conflict of interest the most welcomed policy is to open the facts – to acknowledge the potential COI. Probably in relation to COI it works. But I am in doubt that it works for ghost writing.
The open GW is a legitimization of an unacceptable, probably close to criminal practice.
Medical writers use to say that they provide to authors the professional services for improving their manuscripts. This service is acceptable and has to be acknowledged in the article. The GW is different. Clear.
Vasiliy Vlassov, Moscow